The medical records of patients who had undergone
splenectomy for nontraumatic diseases of the spleen between 1997 and 2000 were reviewed. The aim of the study was to evaluate the short-term outcomes of open and laparoscopic
splenectomies and to determine whether some well-known benefits of laparoscopic surgery could be observed in patients who underwent laparoscopic
splenectomy for nontraumatic
splenic diseases. The data of 44 patients were available for analysis and included 20 patients (45.5%) who underwent laparoscopic
splenectomy and 24 patients (54.5%) who underwent open
splenectomy. Various parameters were reported for open and laparoscopic procedures separately, including associated
surgical procedures, spleen weight, postoperative mortality and morbidity rates, perioperative
blood transfusions, use and length of abdominal drainage, accessory spleen removal,
operative times, length of hospital recovery, and hematologic parameters on admission to and discharge from the hospital. Laparoscopic
splenectomy was successfully completed in all 20 considered patients with no conversion to open
splenectomy. The supine position and four
trocars were adopted in all patients. Accessory spleens were found in four (9.0%) patients: two (4.5%) during open
splenectomy and two (4.5%) during laparoscopic
splenectomy. The postoperative mortality rate was 2.7% (a case of
myocardial infarction). The morbidity rate was 9% (four patients), but no postoperative complications occurred after laparoscopic
splenectomy. A significant statistical difference was shown by the increase in platelet counts after open versus laparoscopic
splenectomy. The open and laparoscopic mean
operative times (73.70 +/- 13.42 minutes and 78.42 +/- 14.63 minutes, respectively) were comparable. These times were comparable also considering patients who underwent only
splenectomy. Mean recovery time was shorter after laparoscopic
splenectomy (3.95 +/- 0.60 days) than after open
splenectomy (7.0 +/- 1.68 days). After open procedures, however, the mean recovery time was shorter in uncomplicated cases (6.68 +/- 1.49 days) than in the open group as a whole. Authors conclude that many well-known advantages of the laparoscopic approach. especially those related to its low invasiveness, can be observed in patients requesting
splenectomy for nontraumatic diseases of the spleen, without lowering the efficacy of this operation. They suggest that such advantages can be entirely displayed when selection criteria of the patients are applied.